Emergency Child Care-Charger Kids Club
This registration form is for the use of Emergency Child Care for Health/Emergency personnel children, District Staff children, Grades Kindergarten-6th.

Phone: 320-286-4100 x1356
Email: CKC@dc.k12.mn.us
Website: https://www.isd466.org/Domain/72
Email address *
Basic Information
Childs Name: *
Your answer
Grade *
Your answer
Gender *
School they attend *
Childs Allergies (if none, put NA) *
Your answer
Childs Diet Restrictions
Your answer
Medications to be given while at CKC
Your answer
Does your child have any of the following? *
Does your child have an IEP/504 Plan? *
If yes to the previous question, what are the needs of the IEP/504 plan?
Your answer
Is your child currently receiving special services (one-on-one help, or one-to-one Para) through the school district? *
If you answered YES to the previous question, please describe:
Your answer
Do you have another (2nd) child to add? *
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